Bronchoscopy

What is bronchoscopy?

Bronchoscopy is an instrumental investigation aimed at the visual exploration of the larger airways (larynx, trachea and bronchi), with primarily diagnostic but also therapeutic purposes.

Bronchoscopy is performed by introducing into the nose or oral cavity a thin and flexible instrument, composed mainly of optical fibers and equipped with a light source and a possible camera at the end. If the doctor deems it appropriate, during the bronchoscopy it is also possible to take small tissue samples which will then be examined in the laboratory. The microscopic examination of these biopsy specimens becomes very useful - for example - to reach a certain diagnosis of lung cancer and to determine its histological type.

The indications that we will develop during the article are of a general informative nature, given that the ways in which the various diagnostic tests are performed can vary from hospital to hospital.

Indications

Bronchoscopy is mainly used for diagnostic purposes, to investigate the origin of particular symptoms or to obtain more information in the presence of anomalous instrumental findings.

Main indications

  • chronic cough of undefined origin that has lasted for at least three months,
  • hemoptysis (expectoration with blood),
  • suspected foreign body in the tracheobronchial tree,
  • atypical chest x-ray with suspicious "shadows"
  • inhalation of toxic gases or chemicals,
  • abnormal phlegm cytology,
  • suspicion of pulmonary infections,
  • sarcoidosis,
  • narrowing or stenosis of the tracheobronchial tree.

Bronchoscopy is also often used in connection with the diagnosis, staging and follow-up of lung tumors, as well as in the search for possible lung metastases or extensions of tumors from neighboring organs (for example from the esophagus).

Bronchoscopy can also be transformed into a therapeutic technique, for example by draining abscesses, restoring the patency of the occluded or restricted airways, removing foreign bodies, aspirating fluid accumulations or mucous plugs, destroying any tumor masses (laser ablation) and perform a diagnostic or therapeutic airway wash.

How is it performed?

Bronchoscopy involves the insertion of a relatively thin and flexible tube (the caliber does not exceed that of a pencil), in the major airways of the lungs.

Thanks to the use of a light source mounted at the apex and the optical fibers, the instrument (called bronchoscope) allows you to visually explore the airways. The most recent bronchoscopes are also equipped with a special camera, which sends recorded images to the screen.

Before starting the exam

Before starting bronchoscopy, you are generally asked to remove any glasses, contact lenses, mobile dental equipment, wigs, make-up, jewelery and hearing aids.

Sedatives and local anesthesia

The procedure is generally not painful, but can cause some discomfort. To eliminate or at least mitigate this effect, an intravenous relaxing drug is administered before bronchoscopy, and local airway anesthesia is practiced (with a gel in the nose or with a spray through the mouth; both generally leave an unpleasant aftertaste ). Often, by intramuscular injection, a drug (atropine sulphate) is administered about 30 minutes before the exam, which reduces secretions and can induce a sense of dryness in the mouth and throat.

Any biopsies do not cause significant pain to the patient; these instrumental maneuvers are carried out by means of special pliers slid into the operating channel of the bronchoscope, until reaching the sampling area.

monitoring and security

As a precautionary measure, an infusion can be practiced in the patient's forearm, which in case of need guarantees an intravenous access for the introduction of liquids or possible drugs during bronchoscopy. At the same time, unless a doctor has already done so, blood is taken to check the blood coagulation function.

During the exam, parameters such as blood pressure, heart rate and blood oxygen levels are continuously monitored. Thus, if necessary, it will be possible to administer supplemental oxygen through a nostril.

duration of bronchoscopy

In all, bronchoscopy lasts about 20-30 minutes, although it is necessary to take into account the long time required for preparation (clinical examination, administration of drugs) and hospitalization (after the examination the patient is kept for a couple of hours to ascertain that there are no complications and dispose of the peak efficacy of the sedative).

Bronchoscopy: execution and risks »

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